Long-term functional and subjective results of thumb replantation

Abstract

The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992-1997, were reexamined after 6.5 years (range, 4.2-9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44 degrees (+/-24.2) and in the interphalangeal joint was 12 degrees (+/-8.4). Grip-strength of the injured hand was 70% (+/-31.4) and pinch strength was 68% (+/-28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation.

Long-Term Subjective and Functional Evaluation After Thumb Replantation With Special Attention to the Quick DASH Questionnaire and a Specially Designed Trauma Score Called Modified Mayo Score

“…Because of the easy comprehensibility and speedy completion and ensuing possibility to use the Quick DASH questionnaire in our daily outpatient clinic, we wanted to investigate whether it correlates significantly with standardized objective measurements of strength, range of movement, and sensibility like the DASH score in other publicized reports (Table 3). 11,12,22 In this literature, no adequate trauma score after thumb replantation was found. Therefore, we decided to develop a specific score to evaluate subjective and objective parameters efficiently and quickly.…”

“…Semmes-Weinstein monofilaments are a nerve tester used to evaluate tactile sensation after thumb and finger replantation in the daily literature. 11,12 Because tactile sensation reflects neural integrity and vascular insufficiency, pathologies can be detected and graded with Semmes-Weinstein monofilaments. Active range of motion was measured for the IP, MCP, and saddle joint by manual goniometry.…”

“…11 Twelve sharp amputations (35%), 12 saw injuries (35%), and 10 crushing/ avulsion injuries (30%) were documented. 11 The classic form of replantation procedure was performed.…”

“…11 Twelve sharp amputations (35%), 12 saw injuries (35%), and 10 crushing/ avulsion injuries (30%) were documented. 11 The classic form of replantation procedure was performed. Approximately bones were shortened 1 mm to 5 mm on each side of the fracture during debridement, and the preferred mode of fixation has been the axial K-wire fixation or small A-O type plates with screws.…”

Selected Outcomes of Thumb Replantation After Isolated Thumb Amputation Injury

“…14 One would expect that isolated thumb amputations would compare favorably with nonisolated thumb amputations with regard to pinch and grip strength. This may reflect the small number of patients in studies reporting on thumb amputations, as well as heterogeneity in the injury patterns for nonisolated thumb amputation.…”